[Is histological examination of every gallbladder really necessary? : A prospective and multicenter evaluation of...

Microscopic examination of surgical specimens (histology) constitutes an indispensable component of the diagnostics and treatment planning; however, the utility of histology in surgery involving predominantly unremarkable findings, such as after cholecystectomy (CHE), is no longer undisputed. The feasibility of selectively submitting surgical specimens following CHE (selective histology) is a subject of increasing discussion.

In this prospective, multicenter study, gallbladder specimens were examined by a surgeon immediately after surgery (between August 2024 and March 2026) to assess the expected histological outcome (perioperative histology). The classification of perioperative histology was carried out in three categories: 1 = no histology required, 2 = histology advisable and 3 = suspicion of cancer. All specimens underwent histological analysis (definitive histology) and the results were likewise categorized into three groups: 1 = mild inflammation, 2 = severe inflammation and 3 = carcinoma. The aim was to determine the level of agreement between the perioperative assessment and the definitive histological findings. P-values < 0.05 were considered statistically significant.

A total of 1040 gallbladder specimens from 4 institutions were analyzed between 1 August 2024 and 31 March 2026. Perioperatively, the surgeons assessed that gallbladder histology was unnecessary in an average of 55% of cases (range: 37%-82%). In 37%-74% of cases, the perioperative assessment that histology could have been omitted (perioperative histology = 1) aligned with a histological finding of mild inflammation (definitive histology" = 1). No carcinoma (definitive histology= 3) was detected in any of the patients for whom histology would have been omitted (perioperative histology" = 1). A suspicion of malignancy was raised perioperatively in up to 7.5% of cases. Overall, 7 patients had malignant gallbladder lesions (0.67%); of these, 4 patients presented with an incidental gallbladder carcinoma (0.38%).

Selective histology following cholecystectomy is effective, sustainable, cost-efficient, medically sound and safe for patients.